1. Assessment of the Cardiovascular System
Health Assessment Across the Lifespan
NRS 102

2. Structure and Function
Subjective Data—Health History Questions
Objective Data—The Physical Exam
Abnormal Findings

3. Structure and Function
Position and surface landmarks
Precordium
Mediastinum
Apex and base of heart
Right and left cardiac borders
Great vessels
Heart wall
Pericardium
Myocardium
Endocardium

4. Precordium, Apex and Base
© Pat Thomas, 2006.

5. Structure and Function (cont.)
Chambers
Atria—right and left
Ventricles—right and left
Valves
Atrioventricular
Tricuspid
Mitral
Semilunar
Pulmonic
Aortic

6. Chambers and Valves
© Pat Thomas, 2006.

7. Structure and Function (cont.)
Direction of blood flow
Cardiac cycle
Diastole
Systole
Events in the right and left sides
Heart sounds
First heart sound
Second heart sound
Effect of respiration

8. Structure and Function (cont.)
Extra heart sounds
Third heart sound
Fourth heart sound
Murmurs
Characteristics of sound
Frequency (pitch)
Intensity (loudness)
Duration
Timing
Conduction
Pumping ability
Cardiac output
Preload
Afterload

9. Structure and Function (cont.)
Neck vessels
Carotid artery
Jugular veins
Internal
External
Venous pulse and pressure

10. Neck Vessels

11. Subjective Data— Health History Questions
Chest pain
Dyspnea
Orthopnea
Cough
Fatigue
Cyanosis or pallor
Chest pain: Any chest pain or tightness? Edition Change: diaphoresis, pallor, palpitations, dyspnea, nausea, tachycardia, or fatigue should be considered to be equivalent to angina.
Dyspnea: Any shortness of breath?
Orthopnea: How many pillows do you use when sleeping or lying down?
Cough: Do you have a cough?
Fatigue: Do you seem to tire easily? Able to keep up with your family and co- workers?
Cyanosis or pallor: Ever noted your facial skin to turn blue or ashen?

12. Health History Questions (cont.)
Edema
Nocturia
Cardiac history
Family cardiac history
Personal habits (cardiac risk factors)
Edema: Any swelling of your feet and legs?
Nocturia: Do you awaken at night with an urgent need to urinate? How long has this been occurring? Any recent change?
Cardiac history: Any history of hypertension, elevated blood cholesterol or triglycerides, heart murmur, congenital heart disease, rheumatic fever or unexplained joint pains as child or youth, recurrent tonsillitis, anemia?
Family cardiac history: Any family history of hypertension, obesity, diabetes, coronary artery disease (CAD), sudden death at younger age?

13. Objective Data—The Physical Exam
Preparation
Position and draping
Room preparation
Order of examination
Equipment needed
Marking pen
Small centimeter ruler
Stethoscope with diaphragm and bell endpieces
Alcohol swab

14. Objective Data—The Physical Exam (cont.)
Carotid arteries
Palpate
Auscultate for bruit
Jugular veins
Inspect the jugular venous pulse
Estimate the jugular venous pressure
Palpate for hepatojugular reflux

15. Objective Data—The Physical Exam (cont.)
Precordium
Inspect the anterior chest
Palpate the apical impulse
Palpate across the precordium
Percuss to outline the cardiac borders

16. Objective Data—The Physical Exam (cont.)
Auscultate the heart sounds
Identify auscultatory areas
Note the rate and rhythm
Sinus arrhythmia
Pulse deficit
Identify S1 and S2
S1 is louder than S2 at the apex
S1 coincides with carotid artery pulse
S1 coincides with R wave on electrocardiogram
Listen to S1 and S2 separately
Listen for extra heart sounds
Listen for murmurs

17. Auscultatory Areas

18. Objective Data—The Physical Exam (cont.)
Characteristics of normal heart sounds
First heart sound
Second heart sound
Splitting of second heart sound
Extra heart sounds
Midsystolic click
Third heart sound
Fourth heart sound
Murmurs
Timing
Loudness
Pitch
Pattern
Quality
Location
Radiation
Posture

19. Sample Charting

20. Sample Charting (cont.)

21. Abnormal Findings Systolic Extra Sounds
Ejection click
Aortic prosthetic valve sounds
Midsystolic click

22. Abnormal Findings Diastolic Extra Sounds
Opening snap
Mitral prosthetic valve sound
Third heart sound
Fourth heart sound
Summation sound
Pericardial friction rub

23. Abnormal Findings Abnormal Pulsations on the Precordium
Thrill at the base
Lift (heave) at the sternal border
Volume overload at the apex
Pressure overload at the apex

24. Abnormal Findings Congenital Heart Defects
Patent ductus arteriosus
Atrial septal defect
Ventricular septal defect
Tetralogy of Fallot
Coarctation of the aorta

25. Abnormal Findings Murmurs Caused by Valvular Defects
Midsystolic ejection murmurs
Aortic stenosis
Pulmonic stenosis
Pansystolic regurgitant murmurs
Mitral regurgitation
Tricuspid regurgitation
Diastolic rumbles of atrioventricular valves
Mitral stenosis
Tricuspid stenosis
Early diastolic murmurs
Aortic regurgitation
Pulmonic regurgitation